Economic anxiety — like the kind brought on by a global pandemic — can cause reduced birthrates.

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Lita Danlag, 29, an ICU nurse from Fort Walton Beach, Florida, had spent more than a year trying to get pregnant. In the winter of 2019, she and her husband suffered a devastating blow when they lost a pregnancy, but they continued trying to the point that it became a singular focus, buying a fertility-tracking smart bracelet to raise the odds.

Then the coronavirus pandemic hit, and everything changed. In the absence of reliable data about how the virus affects newborns, Danlag grew concerned about the prospect of conceiving during the pandemic, and she knew her risk of exposure was high due to her line of work. That became especially true when she decided to move to New York City, the epicenter of the virus, to work at the ICU at NYU Kimmel Pavilion Hospital.

“I’d been so focused on trying to conceive, so it was hard to think of stopping,” she tells Rolling Stone. “[But] after having my first miscarriage I want to do everything I can in my power to make sure I have a healthy pregnancy. I just don’t want to risk it right now.”

Danlag’s individual circumstances may be unique, but the sentiment is not. Demographers are concerned that the pandemic could lead to an even sharper drop in the already-declining birthrate, due to fears about job loss or health concerns related to the virus itself.

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“This is a long-term, huge disruption of our way of life, and it’s pervasive, so it’s hitting all sorts of people different ways,” says Karen Benjamin Guzzo, a sociology professor at Bowling Green State University and acting director of the Center for Family and Demographic Research.

A survey of 132 customers of the ovulation- and pregnancy-test provider Stix found that 56 percent of customers who purchased tests during the months of March and April were trying to avoid getting pregnant. For comparison, the majority of customers prior to COVID-19 were actively trying to conceive, says co-founder Jamie Norwood. “We’ve spent hours on the phone with our customers, and we have heard that they’re changing their plans because of job loss, economic uncertainty, and fear of needing medical care during this time,” she says.

Birth-control providers are seeing an uptick in requests for subscriptions. A representative for Nurx, a subscription birth-control service, said it has seen a 50 percent increase in new patient requests for birth control since early March, as well as a spike in demand for emergency contraception.

With the unemployment rate at record highs and layoffs hitting multiple sectors, many people feel they’re not in a good financial position to have children; those in the middle class who are employed and able to work remotely must grapple with the stress of balancing work with homeschooling and child care. That’s not even to mention health-related anxieties due to the relative paucity of research on how COVID-19 affects pregnancy outcomes. “There’s so much uncertainty,” says Guzzo. “I think people are thinking, ‘Maybe we’ll wait a little bit and see how things turn out’ [before conceiving].” She predicts a “big drop” in births over the next few years.

There’s historical precedent for major crises and pandemics leading to a decline in birthrates. A 2017 paper on the birthrate following the 1918 influenza epidemic in Sweden found that while there was a short-term spike in fertility following the epidemic, “the net long-term effect is fertility reduction,” the study authors write. A study on the aftermath of the Zika epidemic in Brazil found “significant declines in live births” across educational and demographic lines, starting from nine months after the link between fetal microcephaly and the virus was made public.

Economic upheaval and uncertainty has an even more profound effect on birthrates, one that we’ve arguably been seeing enacted on some level since the last recession, says Gretchen Livingston, an expert on fertility and family demographics. “Typically, U.S. fertility does eventually bounce back after economy-related downturns, but that still hasn’t happened, even a decade after the onset of the Great Recession,” she says, with U.S. births steadily falling since 2007. “Now, with the unprecedented economic declines brought on by COVID, it’s hard to imagine fertility ticking up any time soon.”

What a steep decline in birthrates means for the U.S. is not immediately obvious in the short term, but it could be devastating a generation or two out — just look at Japan’s concerns over its low fertility rate resulting in a reduced labor force. But Japan is an extreme example, says Philip Cohen, a professor of sociology at the University of Maryland, and the U.S. population would have to experience a steep decline over a number of decades for this to pose a problem.

“I’m in the camp of people who think we shouldn’t care that much” about a decline in births, he says. But there is a caveat: “If your population is declining it can be an indicator that things are wrong. It might mean people don’t have work-family balance or educate their kids or have health care or have housing.”

The lack of infrastructural support for families has arguably led to the birthrate steadily declining as much as it has in the U.S. — and it’s been exacerbated by the pandemic. “In some ways this pandemic has really stripped everything bare,” says Guzzo. “[We] know on average people still say they want to have two kids. If people aren’t able to do that, that suggests to me our society is failing them, that we don’t have the structures in place that they can have the family they want to have. And that’s sad.”

For those who desperately wish to have children and have struggled to conceive, the pandemic has been nothing short of disastrous: fertility clinics have been shut down en masse following stay-at-home orders. Many older prospective parents with a limited window to conceive will have to balance economic instability and health-related anxiety with their desire to have a family, an agonizing decision that arguably no one in a so-called progressive, prosperous nation like the U.S. should have to make.

But there are those like Robin, 40, a costumer and mother of one in Brooklyn, who are forging ahead regardless. Although she and her husband are both freelancers and must grapple with the accompanying financial uncertainty during the pandemic, they’ve been trying to have another child since last winter, and they don’t have any plans to stop trying. “As a freelancer, you go through periods where there’s no jobs, where you have to basically start from scratch,” she says. “The thought of giving [our child] a sibling is enough of a motivator that I know we’ll just figure it out.”